The focus of this blog is on the wonders of government-run health-care everywhere but I also note the damage done to private medicine by a legal system that supports predatory litigation.

The long-established socialized medicine systems in Britain and Australia are a particularly relevant warning about where such systems end up.

Posts by John J. Ray (M.A.; Ph.D.)

Friday, June 30, 2006

Fat-buster not for NHS patients

A fat-busting drug that not only reduces bodyweight by up to 10 per cent but also helps to tackle other health problems such as diabetes and even smoking has been introduced in Britain. Rimonabant, also known as Acomplia, is the first drug to target a natural body system that governs a host of factors controlling appetite, weight, metabolism and energy use. Research suggests that it has the capacity to combat a smoker’s craving for nicotine.

Britain is the first country to receive Rimonabant, after the decision by drug regulators last week to grant it a licence throughout the European Union. Experts say that 20 per cent of Britain’s population could be eligible for treatment. However, the drug is unlikely to be widely available until it is approved by the National Institute for Health and Clinical Excellence. The institute, which advises on NHS best practice, is not expected to issue guidance on Rimonabant for two years. At a cost of 55.20 pounds per patient per month, or 1.97 per tablet, even treating a fraction of the group eligible could cost the NHS billions.

The drug’s manufacturers, Sanofi Aventis, argues that the drug represents good value for money when set against the 7 billion-per-year cost of tackling the problems connected with obesity and being overweight. Anthony Barnett, a diabetes specialist from the University of Birmingham who took part in yesterday’s launch at the Science Museum in West London, said that it would be a “great shame” if use of the drug was limited by funding issues. “The real question is, can we afford not to treat?” he said.

In a series of trials involving more than 6,000 patients in America and Europe, about a quarter of those taking Rimonabant lost more than 10 per cent of their initial body weight after a year. About a half lost more than 5 per cent of body weight. Waist circumference, seen by many experts as a more important measurement, was reduced by between six and seven centimetres. Significant improvements in measures of glucose control, cholesterol and triglyceride blood fats were also seen. These went far beyond what might be expected simply by losing weight. For example, levels of high-density lipoprotein “good” cholesterol, which reduce heart disease risk, showed an 8 to 9 per cent increase, but only half of this was because of weight loss. There is also trial data suggesting that the drug can help people to give up smoking by overcoming their cravings. However, it is being marketed only to tackle obesity.

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

Thursday, June 29, 2006

U.K.: Call for doctor training rethink

Thousands of doctors could face a "career black hole" under a shake-up of NHS training posts, medics say. About 21,000 junior doctors will be competing for 9,500 training posts in England next year. The British Medical Association's annual conference passed an emergency motion calling on the government to delay implementation of their plans. Doctors said junior medics will either be forced abroad or work in posts with no chance of career progression.

The government is revamping the training process for doctors by scrapping senior house officer posts. Doctors have traditionally gone through three stages of training - pre-registration house officer, senior house officer and finally specialist registrar. Under the government's plans there are just two training phases - a two-year foundation programme followed by a specialist training programme. The government said the aim was to speed up the training of doctors, but doctors said it may be part of an agenda to restructure the workforce.

Doctors who do not get training positions tend to end up in service posts such as staff and associated specialists (SAS) and are used to fill in gaps across departments. The posts offer no opportunity of progressing to become consultants. And as they are paid less than two thirds of what a consultant receives, the move could save the NHS money.

Dr Jo Hilborne, chairman of the BMA's junior doctors committee and a specialist registrar in Cardiff, said thousands of junior doctors were facing a "career black hole". "We are incensed at the cavalier way this announcement was made, with no discussion with ourselves. "This will dispose of the careers and aspirations of 11,500 junior doctors. "There is a concern that there is an agenda in the short-term to push lots of these doctors into service posts."

BMA chairman James Johnson said if the NHS was to lose doctors it had spent time and money training it would be a "terrible waste". "It is a huge crisis looming and it is completely unacceptable."

Health Minister Lord Warner accused doctors of seeking "cheap headlines". "It's absolute rubbish to say there will be thousands of junior doctors without jobs. "Some doctors may have to be flexible, but at the end of the day our changes mean that more doctors will go into specialties where there are shortages and more patients will be treated by trained doctors, meaning that patients benefit."

Shadow Health Secretary Andrew Lansley said medical students had been let down by the government. "I repeatedly questioned Labour over their planning failures for the provision of specialist training posts, but they appear to have proceeded without working them out."

Too many patients are waiting too long to receive treatment in New South Wales public hospital emergency departments, the State Opposition said today. Opposition health spokeswoman Jillian Skinner today said Health Department statistics for April showed 1943, or 18 per cent, of patients with an imminent life-threatening medical condition were not seen within the recommended 10 minutes. An imminent life-threatening condition - such as a heart attack - requires treatment to commence within 10 minutes of the incident occurring.

Ms Skinner said 35 per cent, or 15,701, of patients with a potentially life-threatening condition were not seen within half an hour. These conditions include heavy bleeding, a major fracture, dehydration, and severe illness. Patients must receive treatment within 30 minutes of their accident or illness being diagnosed. Ms Skinner said 31 per cent, or 17,986 patients were not seen within the recommended hour.

Ms Skinner said the Government needed to recruit more nurses so extra hospital beds could be opened. "No matter how creative the spin doctors, the plight of very sick and badly injured patients is at stake, and Premier (Morris) Iemma and his health minister (John Hatzistergos) stand condemned for denying the problem," she said in a statement.

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

Wednesday, June 28, 2006

NHS DOCTORS FED UP WITH CONSTANT GOVERNMENT BUNGLING

The Government’s reform agenda for the National Health Service came under sustained attack yesterday at the annual conference of the British Medical Association. Delegates made plain their opposition to a whole range of reforms in a series of debates that discomfited the BMA’s leadership — including what amounted to a vote of no confidence. A government that was welcomed by doctors when it came to office in 1997, and has spent unprecedented amounts on the NHS, thus finds itself lacking medical support. Speaker after speaker charged Tony Blair’s Government with incompetence, muddle, rushed and ill-considered reforms, and a secret desire to break up and privatise the NHS. The conference agreed to back the campaign group Keep Our NHS Public and only narrowly declined formal affiliation. The group anathematises private involvement in the NHS, seeing healthcare as a public service that can only be delivered by public servants.

The conference, which is the BMA’s policymaking body, also passed by a clear majority a resolution that declared the BMA leadership had failed “patients, the profession and the country by their failure to actively oppose the current wave of organisational and financial reforms which are destabilising the NHS”. The leadership defended its engagement with the Government, saying that to influence policy it needed to be in regular contact, but delegates passed the motion by a 58 to 42 per cent vote — a sharp and unexpected reverse. Moving the no-confidence motion, Natasha Arnold, from Islington, North London, said there was “a real and imminent danger to the future of the NHS”.

Earlier, one of the leaders of Keep Our NHS Public, Jacky Davis, said that the Government increasingly saw the NHS as no more than a “kitemarking”, or rubber-stamping, organisation that would certify treatments delivered by others.

Sir Alexander Macara, a former BMA chairman, said of the Government: “As well as providing new resources, it has introduced cavalier and ill-founded reforms based on an arrogant belief in the rectitude of its own theories. We must say to the Government, ‘Get on the right planet and listen to doctors’. We must ask the Government to have the courage and humility to say, halt.” This seems very unlikely, at least while Mr Blair remains at No 10. For him, reform is not fast enough. He believes that to improve efficiency and productivity the service has to endure some pain, and is likely to see yesterday’s debates as evidence that this is happening.

Earlier, James Johnson, chairman of the BMA Council, had criticised the “breakneck pace and incoherent planning” of the NHS reforms, which include patient choice, payment by results, and practice-based commissioning. Payment by results aims to pay hospitals per item of service, a policy likely to encourage them to do more and suck in huge amounts of NHS money. To counteract this, practice-based commissioning aims to put the power over money in the hands of GPs, who will want to retain as much of it as they can in primary care.

In theory, the two policies should create a pseudo-market that drives efficiency and shifts care out of expensive hospitals and into affordable primary care. But the policy has the air of having been assembled hurriedly. “The NHS is in danger and doctors have been marginalised,” Mr Johnson said. “Everyone is telling the Government: you must get the professions on board; you must involve clinical staff; you can’t make this work without doctors. “The Government’s favoured method of raising quality and keeping prices down is to do what they do in supermarkets and offer choice and competition,” he said. “But will it work in a health service? More ‘customers’ — we doctors are old-fashioned enough to call them patients — does not mean profit, it means more costs.”

Mr Johnson’s call for a line to be drawn in the sand was well received, but delegates had come to the meeting determined to give him and the rest of the BMA leadership a bloody nose, which they duly did two hours later. The Government can expect a more combative BMA, but may not mind. To it, how doctors behave is part of the problem, not part of the solution. The question is whether any health service can be delivered efficiently by a disaffected and truculent workforce.

The new chief of the Health Quality and Complaints Commission was a senior Queensland Health boss whose failure to resolve formal complaints over unsafe hours at Bundaberg Hospital led to surgeons quitting and Jayant Patel being hired. Dr John Youngman, a deputy director-general of Queensland Health during the discredited leadership of former Health Minister Wendy Edmond, will lead the new commission and oversee complaints from consumers, hospital staff and whistleblowers. He will work two days a week for $100,000 a year to head a board of five assistant commissioners including a former Beattie Government director-general Marg O'Donnell, whose husband Justice Martin Moynihan shut down the health inquiry for "ostensible bias".

Senior clinicians told The Courier-Mail yesterday the elevation of Dr Youngman was extraordinary given his previous No. 2 role in Queensland Health, which was found to have had a "culture of concealment" in inquiries by Tony Morris, QC, and Geoff Davies, QC. The head of the Patients' Support Group, Beryl Crosby, also slammed the appointment and said the Bundaberg Hospital disaster would not have happened if Dr Youngman had been more responsive to the pleas from surgeons for help. "It is bizarre that they would put someone in as head of the complaints unit who did not listen to complaints in the first place. This will not inspire confidence," Ms Crosby said.

In unchallenged evidence at the inquiry it was revealed that pleas by Bundaberg Hospital's then director of surgery, Dr Charles Nankivell, for urgent help were not dealt with by Dr Youngman in his role at the time as general manager (health services). Dr Nankivell had been pleading in writing for top-level intervention because he had been working dangerously long hours and feared his chronic fatigue would harm patients and himself. He had written to the heads of the hospital and the heads of Queensland Health to raise the concerns before patients were unnecessarily maimed or killed.

Dr Youngman's written response, described in the Commission of Inquiry report as "trite", did not address the safety concerns. Dr Nankivell, who quit in disgust, told the inquiry that Dr Youngman's response was the straw "that broke the camel's back". Dr Nankivell was replaced by Dr Sam Baker, who also quit in disgust, resulting in the hiring of the incompetent Jayant Patel who had been banned from performing surgery in the US. .

Dr Youngman told The Courier-Mail yesterday he had no recollection of the complaints by Dr Nankivell and Dr Baker, nor was he aware of their unfavourable evidence. He said the Davies inquiry had made no findings adverse to him and that his track record in safety and quality underlined his commitment to better health care. Dr Youngman said he had worked hard with limited resources and that as a top administrator he had not personally been part of a "culture of concealment". "From my point of view I undertook a very transparent role. I'm sure there are many people who support me and some who would not support me," he said. Dr Youngman has been working since last year as a consultant to Health Minister Stephen Robertson.

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

Tuesday, June 27, 2006

U.K.: Choice between tweedledum and tweedledee fails to please

The Government’s choice agenda in the National Health Service is failing to satisfy patients, according to a survey. Released by the British Medical Association in Belfast as it assembles for its annual meeting, the survey suggests that NHS patients want to have choice, but would prefer choices other than those being offered by the Government. As a result, 55 per cent said that the NHS did not offer choice — even though the Government has extended its policy of providing a choice of hospitals. Patients can choose from five places to have operations, usually including at least one private-sector centre.

When participants were asked what choices they wanted to be able to make, 69 per cent said it was very important “to have a say in things generally”. Almost as many chose “timing of treatment”, then a choice of GP, type of treatment and specialist, in that order of preference. Just over half of the 1,077 adults interviewed by Andrew Irving Associates for the survey said they thought that choice of hospital was very important. Nearly a quarter said that hospital choice was the first thing that occurred to them when considering choice in the NHS. Only 7 per cent said that a say in things generally was on offer, even though that was what the majority of participants said that they wanted.

James Johnson, chairman of the BMA Council, said: “Patient choice is on the lips of every politician and drives the NHS reform agenda. “We wanted to find out what it means for ordinary people and how important it is to them. We found some suprising results which don’t seem to match government thinking. Most strikingly, the majority of people said that the NHS did not offer choice. “The concept of choice is very popular, but people’s priorities aren’t in line with the Government’s. The majority who thought there was no choice have either not been listening to the propaganda, or have been listening and haven’t been impressed.”

NHS reforms are set to have a high priority at this week’s conference, with a lengthy debate tomorrow on the reform of the NHS in England, followed by votes on detailed resolutions on the subject on Wednesday. “It’s a central issue for us and this is a very timely moment,” said Dr Michael Wilks, who will chair the conference. Other contentious issues to be discussed include the advertising of food and drink, putting GPs’ surgeries in supermarkets, the NHS IT system, education and training of doctors, and euthanasia.

Doctors are expected to express strong views on NHS deficits at a time when NHS spending has doubled. Some troubled hospitals have sought cuts in staff levels that could affect doctors. Mr Johnson reacted to reports that the Oxford Radcliffe Hospital had made two consultants redundant by saying that any redundancies among doctors would be “absurd and ridiculous”. Britain still had too few doctors, he said. “The whole emphasis of the Government’s policy has been on increasing doctors and medical students. It is a huge waste if it is going to pay to train doctors and them make them redundant. “We’re not prepared to see valuable assets wasted,” he said. “We will do everything in our power to help any doctors threatened with redundancy.”

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

Monday, June 26, 2006

NO CASH SO DOCTORS DISMISSED IN UK

Two doctors at a leading NHS hospital have become the first consultant surgeons to be made redundant as a result of the financial crisis in the health service. Oxford Radcliffe Hospitals NHS Trust, which has a 33 million pound deficit, has given two consultant gastrointestinal surgeons, one full-time and one part-time, three months’ notice. One of the surgeons, Simon Cole, is a former president of the Association of Surgeons in Training, while the name of the other has not been disclosed.

Jonathan Fielden, deputy chairman of the British Medical Association’s (BMA) consultants’ committee, said: “This is a deplorable step that shows the state of the financial crisis that many trusts are in. This will have a significant impact on patient care.” A trust spokeswoman confirmed the trust had to save 33 million pounds this year, adding: “A review indicates, among other things, a reduced number of gastrointestinal procedures. We are, therefore, matching our capacity to the reduced use of this service.”

The move comes as Debbie Abrahams, chairwoman of Rochdale NHS Trust, disclosed this weekend that she was resigning her post because of her anger at the use of private health companies in the NHS. At this week’s BMA annual conference its chairman James Johnson is expected to say the government’s NHS reforms have delivered poor value for money. He said that despite massive funding increases there has not been a dramatic improvement in patient care. “The NHS has got better, but not commensurately better, for the very large amounts of money spent,” he said.

Two official reports this week — one from the Organisation for Economic Co-operation and Development (OECD) and one from the government’s NHS inspectorate — are expected to show patients are still receiving substandard care. The OECD report will show that, in some areas, the NHS is lagging behind health services in 30 other European countries. It is expected to disclose: * Death rates from breast cancer in Britain are higher than in most other European countries. * Britain has fewer radiotherapy machines for treating cancer than most other European states and only a fraction of the numbers in France, Switzerland and Denmark. * The NHS has fewer doctors than European neighbours and almost half the ratio of doctors to patients as Greece and Italy.

The NHS inspectorate’s report is expected to say that services for chronic lung disease, which affects 3m patients in Britain, have been badly neglected. The Healthcare Commission will say that NHS treatment for conditions such as emphysema and bronchitis needs to be improved urgently. Chronic lung disease kills more than 30,000 every year, almost double the European average. The commission will add that patients suffering from respiratory disease have been given the wrong diagnosis or have not been diagnosed at all, leading to them being denied care. It will say the equipment available in the NHS to diagnose chronic lung disease is ineffective and that doctors and nurses do not know enough to operate the machines and interpret the results. Patients who are diagnosed with lung disease do not receive adequate health checks resulting in them losing out on necessary treatment.

Patient care could be further damaged by the government’s radical reforms, Johnson will tell the BMA conference. He says the government’s policy of allowing patients to choose to be treated at private hospitals could undermine the NHS. He will warn that district general hospitals running casualty departments, intensive care units and maternity wards could close as treatment is siphoned off to privately run treatment centres. The Department of Health said patient care had improved dramatically, with record funding resulting in more doctors and nurses, wider access to medicines and the shortest-ever waiting times

More than 50,000 Queenslanders have given up trying to see a public dentist because of waiting times of up to five years, new figures reveal. Opposition health spokesman Bruce Flegg said the dental service was on the verge of collapse despite State Government claims of record funding. Dr Flegg said the waiting periods had resulted in general dental clinic treatments falling almost 20 per cent from 296,000 patients in 2004-05 to 240,000 in 2005-06. School dental clinic treatments had also fallen, from 670,000 to 630,000, over the same period. "Queenslanders are not getting value for the huge injection of taxpayer funds," Dr Flegg said.

The Australian Dental Association said in December that waiting times for Queensland public dental services were up to five years for a basic check-up. The Government's inability to attract staff meant the situation was unlikely to get better, it said.

The Opposition said it was not surprising that with fewer patients accessing treatment, dental emergencies at public hospitals had jumped 10 per cent. "These figures just blew me away . . . it reveals the extent of government mismanagement," Dr Flegg said.

Gold Coast pensioner Wayne Webb said he gave up waiting after three years - using his life savings of $5000 to get new teeth. Mr Webb, 52, told The Sunday Mail he first went for treatment at a clinic attached to the Gold Coast Hospital in 2003 and was told he was on an emergency waiting list. "They said to just wait. But I was in so much pain, I could not eat, I had to do something," Mr Webb said. "Stuff Mr Beattie. He promises all this money in the Budget to fix health, but what has he done for me? Nothing."

Health Minister Stephen Robertson said the Government would spend $137 million in 2006-07 to provide free public dental services - up $5.3 million on 2005-06. His office provided figures for the number of dental treatments in 2005-06 but no comparisons with the previous year. He said Queenslanders enjoyed Australia's "most comprehensive" public dental service and the Government would continue to push for the federal scheme to be reinstated.

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

Sunday, June 25, 2006

U.K.: ELITE DOCTORS LEFT JOBLESS BY "CUTS"

A group of junior doctors selected for a specialist course designed to train the next generation of GPs has been left jobless after offers were withdrawn because of NHS funding cuts. The 29 doctors, who have studied medicine for at least six years, learnt this month that they would not be able to join their three-year course in August. The Innovative Training Posts, the final stage of formal education, were introduced to single out and nurture the best primary-care talent. The course involves two years concentrating on various specialities in hospital medicine and one year as a GP registrar.

The junior doctors, many of whom are burdened with student debts, have been told that they must defer starting the training until February. It remains unclear how the funding shortfall will be remedied by then, when budgets are normally more stretched in the run-up to the end of the financial year. Doctors’ leaders gave warning yesterday that such drastic actions were destroying workforce morale and creating a uncertainty and disaffection with the NHS. They added that the future of healthcare was being severely compromised by the growing financial problems of the health service.

Many of the junior doctors, who qualified for the course after sitting a series of interviews and examinations, have been unable to get interim hospital jobs as all senior house officer positions have been filled. The crisis, caused by budget cuts by the London Deanery and ordered by the Department of Health, is the latest to hit the NHS as it struggles with an annual deficit of more than 500 million pounds.

Richard Savage, course organiser of the Guy’s and St Thomas’ Hospital vocational training scheme, who was involved in the training of three of the doctors, described the action as outrageous. “The bureaucracy in the NHS is now so disjointed that there is no forward planning,” he said. “It is simply worked from one financial year to the next.” The British Medical Association (BMA) said that it was seeking the urgent intervention of Lord Warner, the Health Minister, to resurrect the training of would-be GPs, who were from around the country and to be based in London.

Hamish Meldrum, the chairman of the GPs’ committee of the BMA, said that even if they managed to restart the course next year, the precedent was very dangerous and left them few employment prospects in the meantime. “Underlying this story is the problem that doctors’ training is under growing financial pressure,” Dr Meldrum said. “The country is crying out for fully trained GPs. It would be a tragedy not just for these doctors but also for patients and the wider NHS if medical training is cut as a result of NHS deficits.”

The London Deanery and the Department of Health denied that the course was being cut and said that they expected the students to begin their training in the new year. “We are reassured that the deanery is working with the BMA and doctors affected to offer them careers advice and support so that this has as little impact on their professional and personal circumstances as possible,” a department spokeswoman said

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

Saturday, June 24, 2006

U.K. TO REVERSE COURSE ON IVF?

The present policy discourages it on pennypinching grounds -- but now they are beginning to realize that they need all the babies they can get!

Making fertility treatment freely available to all would boost Britain's population and help stave off the looming pensions crisis, scientists said yesterday. Using the latest figures on the costs of fertility treatment, researchers calculated the total value of an IVF baby to the British economy and compared it with a baby conceived naturally. They found that if the government invested in IVF and offered three cycles of fertility treatment on the NHS, the country would increase its population by 10,000 within two to three years. Currently only a quarter of IVF treatment is conducted by the NHS. Their calculations showed that once the extra cost is taken into account, every person born through IVF would on average contribute 147,138 pounds to the economy, compared with 160,069 pounds generated over the lifetime of a person conceived naturally.

"If a government invests in IVF treatment, essentially by paying for that treatment, and a baby results, the government starts earning money back two years later than if the baby was conceived naturally," said Professor Bill Ledger, head of reproductive medicine at Sheffield University.

The calculations are the first attempt to assess the value of children born through IVF to the British economy. The researchers worked on the basis of the child living to the average male age of 78, and the cost of IVF being 12,931 pounds per conceived live birth. In 2004, the National Institute for Health and Clinical Excellence, which governs what medical treatments are available on the NHS, recommended that couples should be offered three cycles of IVF on the NHS, but many primary healthcare trusts are unable to afford the cost.

Prof Ledger said he wanted to see universal NHS funding of three IVF cycles, instead of the current "postcode lottery" system which resulted in an average of less than one cycle being state-supported. Speaking at the European Society of Human Reproduction and Embryology yesterday, Prof Ledger said that providing three cycles of IVF to all couples would cost the government an extra 50-80 milion pounds, but the cost would quickly be recovered by taxes made from the boosted population.

In a separate study, Jonathan Grant, director of the Cambridge-based thinktank, found that more government funding of IVF would help improve Britain's low birth rate, which although at a 13-year high of 1.8 births per woman, is still below the 2.1 figure needed to maintain the population size. Without new policies to increase fertility rates, Britain and other countries in Europe will face ageing societies that cannot be supported because the workforce is too small. Predictions suggest that by 2050, a third of Europeans will be older than 65. "If three cycles of IVF were available on the NHS, we think we could put another 10,000 births into society from couples who are otherwise not going to have children," said Prof Ledger. "All we would like to see is three full cycles of IVF for all women who are eligible."

Other countries have already moved to bolster their populations by funding more IVF. In Denmark, 3% of children are born through IVF, compared with just 1% in Britain. In South Korea, where the fertility rate is 1.08, one of the lowest in the world, the government has pledged $38bn over five years to encourage couples to have babies. "If Gordon Brown is concerned about where his pension fund is going to be coming from, then it's clear that IVF can contribute to the economy significantly. It's really a win-win situation," said Dr Mark Hamilton, chairman of the British Fertility Society. "This isn't fertility clinics trying to drum up business. There are those who want babies through IVF but they can't afford it."

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

Friday, June 23, 2006

NHS PENNYPINCHING (1)

Short term thinking

New guidelines for saving NHS money by prescribing older, cheaper heart drugs will mean less effective care for some patients, specialists claim. Primary care trusts have been told that at least 60 per cent of prescriptions for life-saving statin drugs should be for simvastatin and pravastatin, which are out of patent and much cheaper than newer, more potent statins. The policy emerged quietly last week as part of a report from the NHS Institute for Innovation and Improvement that claimed productivity and efficiency savings could be worth 700 million pounds a year. While the report makes no mention of any new target, an accompanying document says that generic statins should represent a minimum of 60 per cent of all prescriptions. “Greater savings will be achieved for larger shifts,” it says. While primary care trusts cannot force GPs to prescribe particular drugs, they can exert considerable pressure.

Pfizer, the drug company that makes Lipitor, the statin likely to lose market share as a result of any enforced change, says that the policy risks reversing recent advances in the management of heart disease. Olivier Brandicourt, Pfizer’s managing director, said: “Not only does this represent bad medicine and a further assault on clinicians’ freedom to prescribe the most appropriate medicine for their patients, but it could also slow progress towards the Government’s own goal of significantly reducing deaths caused by coronary disease by 2010.” He is backed by heart specialists.

John Betteridge, Professor of Endocrinology and Metabolism at University College London, said: “It is crucial that the quest for savings on prescribing costs for statins should not lead to less effective care for individual patients at high risk of cardiovascular events. I fear that this may be the case.” Professor Paul Durrington, of the Cardiovascular Research Group at the University of Manchester, said: “This is essentially robbing Peter to pay Paul. “Substantial numbers of patients with above-average cholesterol levels will fail to hit the Department of Health’s own targets with generic statins and these are also the targets GPs are contracted to achieve. “Failing to achieve these targets will translate into more expensive hospitalisation and surgical intervention.”

A recent paper in the British Medical Journal suggested that, at the right dose, all statins were of more or less equal potency, and that 2 billion could be saved over five years if the NHS prescribed only simvastatin. But Pfizer cites trials in which Lipitor produced greater reductions in cholesterol levels than simvastatin. Dr Berkely Phillips, medical adviser to the company, said: “The most important thing is that we are moving to new, lower targets for cholesterol. “The current target is 5 mmol/litre of total cholesterol but the Joint British Societies — the British Cardiac Society, the British Hypertension Society, Diabetes UK, Heart UK, the Primary Care Cardiovascular Society and the Stroke Association — have recommended that the target should be 4 mmol/litre. “On 40 mg of simvastatin, a normal dose, only 33 per cent of people would reach this target. Lipitor [atorvastatin] is more potent.”

The Department of Health denied that there was any new target. A spokesman said: “This is guidance for trusts showing the potential savings that could be achieved if their GPs prescribe lower cost statins.” He added: “There is no government ‘cholesterol target’. However, under the new GP contract, doctors are rewarded for controlling the cholesterol level of patients with coronary heart disease. We are not aware of any evidence that shows the prescription of low-cost statins — in line with guidance from the National Institute for Health and Clinical Excellence — will reduce the effectiveness of this measure.”

British couples who have difficulty starting a family are among the least likely in Europe to receive the IVF treatment that they need. According to a new league table published yesterday, Britain came 12th out of 15 countries that provided data for 2003, with only Macedonia, Croatia and Austria performing fewer cycles of fertility treatment per head of population. Clinics in Denmark, the top-rated country, where most IVF is provided free by the State, conducted 2,031 cycles per million inhabitants, compared with 633 in Britain. France, the country most comparable in size, comes ninth, with 1,009.

In global terms, Britain finished 16th out of 34 countries. Most of the lower-ranked nations, with the exception of America, which has no reimbursed provision of IVF, are from the former Soviet bloc, the Middle East or Latin America. Israel headed the world table by a distance, with 3,263 cycles per million; IVF is available free, and without limits.

Anders Nyboe Andersen, of Copenhagen University Hospital in Denmark, who led the team that compiled the European data, said that Britain’s position came as no surprise given the low priority that funding IVF receives from the NHS. While the National Institute for Health and Clinical Excellence (NICE) has recommended that three cycles be provided free to most couples in which the woman is under 40, the Government has asked primary care trusts to pay for only one and many do not offer even this limited service.

North Lincolnshire PCT is the latest to scrap free IVF treatment because of financial deficits. Dame Suzi Leather, chairman of the Human Fertilisation and Embryology Authority, recently described access to IVF as “the No 1 problem faced by patients” and called on the Government to implement the NICE guidelines. Dr Andersen told the European Society of Human Reproduction and Embryology conference in Prague: “The main reason for Britain’s position is that (IVF) is not available from the State.”

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

Thursday, June 22, 2006

Young 'failed' on mental health

Mental health problems in children and adolescents are on the rise, the British Medical Association has warned, and services are ill-equipped to cope. One in ten children, aged one to 15, have a mental health problem, says a report from the BMA's board of science. But mental health services are failing the most vulnerable, such as children in care and those from black and ethnic minorities, they conclude. The board has urged the government to address problems with funding.

Around 1.1 million children under the age of 18 would benefit from support from specialist mental health services, the BMA has estimated. Children from poorer backgrounds, children in care, asylum-seeker children and those who have witnessed domestic violence, are all at particular risk of developing mental health problems, the report says. But vulnerable children may become stigmatised and struggle to access overstretched services.

The mental health problems covered by the report included depression, anxiety, self-harm, attention-deficit hyperactivity disorder, eating disorders and obsessive disorders. It is estimated that 1% of children and 3% of adolescents suffer depression in any one year. Self-harm is also on the increase with 11.2% of girls and 3.2% of boys committing an act of self-harm.

The figures suggest boys and girls tend to suffer from different mental health problems. Girls tend to have more emotional disorders such as anorexia, with a higher prevalence of conduct disorders such as frequent and severe temper tantrums among boys.

The board said that government policies designed to tackle the problem, including moves to reduce child poverty, must be properly implemented. They called for adequate funding and staffing of child and adolescent mental health teams, improved services for children in care and said racism within mental health services must be eliminated. And teenagers aged 16 to 18 years must receive appropriate care for their age and not just be passed on to adult services, they concluded.

Dr Vivienne Nathanson, Head of BMA Ethics and Science, said: "Children from deprived backgrounds have a poorer start in life on many levels, but without good mental health they may not have a chance to develop emotionally and reach their full potential in life. "There are a number of government policies currently being rolled out that are aimed at tackling these problems. It is essential that they deliver what they promise."

Dr Marcus Roberts, head of policy at mental health charity Mind, said: "This important report reminds us that environmental and social factors have a big effect on mental wellbeing, and also that services for young people's mental health are frequently lacking. "It's crucial that the right kind of services are there to break what can become a cycle, wherein poverty contributes to mental distress, which in turn leads to unemployment, stigma and further poverty."

Avis Johns, YoungMinds Development Director agreed: "With the majority of adults with mental illness able to trace their symptoms back to childhood it is essential we act now to prevent a generation of children being blighted by mental ill health."

Shadow Children's Minister Tim Loughton condemned long waiting lists for child mental health services, and the fact that some young patients were being forced to spend time on adult mental health wards because specialist services were not available. He said: "The government must take urgent action to make children's mental health services a priority.

A spokeswoman from the Department of Health said between 2002 and 2005 the number of staff working working in child and adolescent mental health services increased by more than 40%, and the number of cases seen has also increased by more than 40%. She said 300 million pounds had been invested in the service in the last three years, and experts were advising on how best to improve services. "The Department expects local specialist commissioning groups to use this cash to finance in-patient psychiatric units which allow for effective service planning for the local population."

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

Wednesday, June 21, 2006

HUGE NHS DELAYS HURT WOMEN

Women with a family history of breast cancer are being forced to wait so long for test results that some choose to have their breasts removed before they know whether they have the faulty gene, say health campaigners. A report by the charity Breakthrough Breast Cancer says that women are suffering "agonising delays" of two years or more for genetic test results. Many women had undergone private tests in the meantime, but others had resorted to mastectomies rather than risk developing the disease.

The charity said that in some parts of the country tests could take just a few weeks, but it emphasised that there were wide variations between laboratories and that the process was causing unnecessary anguish. It said that some women tested in 2002 were still waiting. In 2003 the Government promised that by 2006 anyone taking a genetic test should get their results within ten weeks.

The Government said yesterday that laboratories were "making excellent progress" towards meeting the goal. About 5 per cent of the 41,000 cases of breast cancer diagnosed in Britain each year are due to inherited faults in genes associated with strong family histories of the disease. A further 10 to 15 per centoccur in women with moderate family histories.

Most genetic tests look for changes or faults in the genes BRCA1 and BRCA2. A woman with a fault in one of these is up to 85 per cent likely to develop breast cancer, and up to 40 per cent likely to develop ovarian cancer.

Genetic testing involves a two-step process. First, in the diagnostic part, a living relative with breast cancer is tested. Next, the healthy person is tested to see if she has inherited the fault. This is called predictive testing.

The charity surveyed 27 genetic counsellors and more than 50 women who had been genetically tested. More than half of the counsellors had patients who had opted to have their breasts removed while waiting for their results or the results for an affected relative. Jeremy Hughes, the chief executive of Breakthrough Breast Cancer, said that it was unacceptable that women were forced to put their lives on hold while waiting for vital test results. He said: "The decision to take such a test is extremely personal, complex and difficult enough. That some then feel compelled to make crucial healthcare decisions out of fear of developing breast cancer while waiting for their test results is appalling."

A spokeswoman for the Department of Health said that waiting times for results had been a problem. She said that an extra 18 million pounds in funding had been allocated to NHS genetic laboratories to speed up the process. "They are making excellent progress towards this important goal."

A boy who fell through an aquarium almost bled to death because an ambulance was diverted to treat a man whose throat became sore after eating a hamburger, paramedics claim. The boy, 12, from Mooloolaba, had to wait 30 minutes before another ambulance arrived to take him to Nambour Hospital.

The mix-up has been blamed on a faulty computer system and lack of experienced staff at a Queensland Ambulance Service communications centre on the Sunshine Coast. "The QAS management have assured the public that all the problems have been rectified, yet situations like this continue on a daily basis," a senior ambulance source said. "The computer system does not work and the operators don't have any clinical knowledge, so there is a huge risk that people could die unnecessarily."

But a QAS spokesman yesterday said the boy did not have life-threatening injuries and his case was given a Code Two (non-urgent) priority. The ambulance arrived after 27 minutes. "This matter was correctly coded and dispatched accordingly, the spokesman said. "From all the facts available, it was a straightforward case."

The source said an ambulance was dispatched to the boy after he crashed through the aquarium at his home a fortnight ago. But the paramedic was diverted to another "higher priority" case. "The second patient had been sick with a sore throat for a week and had aggravated it by eating a Big Mac," the source said. "Once the paramedic told the guy to gargle his medication, as prescribed by his doctor, she was again dispatched to the boy. "In her words they were `the most horrific injuries that I had seen that hadn't come out of a car accident - there was over half a litre of blood on the floor, the thigh bone was visible, as were tendons and a lot of tissue'."

The source said call centre workers were inadequately trained and crews frequently responded to "Code One" emergency calls that were little more than patient transfers to hospital. "Ring up with a runny nose or be involved in a minor nose-to-tail and you will get an ambulance Code One. But ring up after falling through an aquarium, or collapse with a stroke on the footpath, and your ambulance will probably take half an hour or more to get there," the source said.

The Sunday Mail reported in January how a Kilkivan man almost died when the ambulance service ignored his wife's initial call for help after a machine accident. Paramedics were dispatched only after she called a second time, an hour later. Ambulance Commissioner Jim Higgins blamed that delay on a fault with the dispatch system. A communications officer was counselled over the incident, but frontline staff complained that many Triple-0 calls went unanswered.

The article above appeared in the Brisbane "Sunday Mail" on June 18, 2006

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

Tuesday, June 20, 2006

There is no right to medical care

In the advertisement "A Renewed American Agenda" (USA Today, May 4, 2006)—placed by The Bedell World Citizenship Fund of Spirit Lake, Iowa, the organization urges us to "Recognize that All Americans Have A Right to Medical Care." I suppose they mean well but in fact they are perpetrating a gross misunderstanding about individual rights.

First, those who belong to this organization may mean no more than that we in these United States of America have a legal right to medical care, which is true enough but not crucial since governments can establish such rights—entitlements—whether justified or not. Those who have power have always been able to confer legal privileges on others especially if they can obtain these privileges from people by force of arms, by taxation or outright conscription.

Second, and which is the more vital point to make in response to this claim about a right to medical care, no one in fact has a natural right to medical care comparable to one's right to life, liberty, the pursuit of one’s happiness, private property, and so forth. These are what political theorists call negative rights because all they require is that people refrain from intruding on one another. But in fact no one can have a right to medical care because if one had such a right, others would lose their basic rights to liberty, and to property, which are unalienable and cannot be lost (only violated).

Medical care is a value doctors, nurses and other medical professionals would, if they were free men and women, provide to those they would choose as recipients, on terms they regard as acceptable. These provisions are not owed to anyone. Doctors, nurses, and other medical professionals may not be placed into involuntary servitude to those needing their services—the relationships must be voluntary, no matter how vital those services are to the recipients.

The belief that others may justly be placed into involuntary servitude so as to secure funds to pay medical professionals—who then will service those who need their work—is a gross error. In a free country—a just country—adult men and women treat each other as ends in themselves, not as unwilling tools, instruments, or means to each other’s ends. Just as I may not go over to my neighbor’s home and conscript some unwilling individual to come and mow my lawn or even drive me to the hospital (but must ask for this and await willingly given help), so any service such as medical care must be obtained without coercion.

There are those, of course, who believe that once it has been democratically determined that people must pay for medical services to all, there is nothing wrong with collecting the taxes for this purpose. This is wrong—no group or majority of a group may decide to take what belongs to people. It is no less unjust to do such a thing than it is to hang someone because the majority in some town decides it’s OK to do so, without first following due process, namely, demonstrating via the justice system that the hanging is deserved.

It needs to be reiterated again and again that taxation is a reactionary device that had been used by monarchs to collect “rent” from the folks who lived and worked on what the monarch (misguidedly) believed was his or her property. Taxation went hand in hand with serfdom and neither has a place in a free society where individual citizens are sovereign, not their government (which is merely an administrative agency to secure the rights of all the citizens, even non-citizens, of a country).

The myth of having a right to medical care—or all sorts of other services that need the work or resources of others—generates the mentality that people can proceed with their lives without having to be responsible for what living entails. These are all kinds of costs one must cover and be prepared to cover, alone or with the voluntary cooperation—trade, charity, generosity, or grant of loans—of others. Dumping these costs on unwilling others is like dumping pollution on unwilling others, a natural crime. The folks at the Bedell World Citizenship Fund ought not to be complicit in peddling the perverse political ideology that supports such practice.

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

Monday, June 19, 2006

Campaign on Hospital Errors "Saves Lives"

A campaign to reduce lethal errors and unnecessary deaths in the nation's hospitals has saved an estimated 122,300 lives in the last 18 months, the campaign's leader said Wednesday. "I think this campaign signals no less than a new standard of health care in America," said Donald Berwick, a Harvard professor who organized the campaign.

About 3,100 hospitals participated in the project, sharing mortality data and carrying out study-tested procedures that prevent infections and mistakes. Experts say the cooperative effort was unusual for a competitive industry that does not like to focus publicly on patient deaths. "We in health care have never seen or experienced anything like this," said Dr. Dennis O'Leary, president of the Joint Commission on Accreditation of Healthcare Organizations.

Dr. Berwick of the Harvard School of Public Health announced the campaign's results Wednesday at a hospital conference in Atlanta. Dr. O'Leary was one of hundreds of industry dignitaries and representatives in attendance.

Medical mistakes were the focus of a 1999 report that said 44,000 to 98,000 Americans die each year as a result of errors and low-quality care. The changes Dr. Berwick sought included the deployment of rapid response teams for emergency care of patients whose vital signs suddenly deteriorated. Another change urged checks and rechecks of patient medications to protect against drug errors.

Perhaps my hospital did not participate in this study. I serve on the Quality Management committee, which investigates "medical" errors of any severity. I certainly would be aware of any deaths due to "medical errors". Based on The numbers reported (100, 000 deaths), our city should have several hundred such deaths. This is simply not true.

Dr Berwick must have taken a number from somewhere, but not from real world data. Some analysis has suggested that these alleged numbers consider those who have died where "medical errors" have been reported. This does not prove causation.

For example, it is easy to accumulate such numbers. If someone misses a dose of medication, or gets the wrong medication, this is counted as a "medical error". This type of error seldom leads to death. It is sloppy medicine, and is improved by constant attention. In truth, this procedure has long been on-going. Hospital committees keep track of these errors, and counsel people to do a better job of tracking this stuff. Many such people later go on to die, but counting a "medical error" by itself in no way indicates causation.

Dr. Berwick claims to have saved 122,300 lives out of 44,000 to 98,000 lives. Appears somwehat contrived to me - saving more lives than are allegedly lost.

Perhaps we were ahead of the rest of the country. "Rapid response teams" (code teams) have been around long before the 1999 report. And "checks and rechecks of patient medications" have been standard practice for a long time before 1999.

No doubt Dr Berwick and others have spent a lot of grant money studying this "problem". So self congratulation and declaring success is of course expected, and essential so they can have their grants renewed and continue their academic careers.

No doubt President Bush will hear of this. No doubt he will be convinced that more of "the poor" die due to "medical errors". To prove he is "sensitive" to "the poor", he will sign a bill requiring billions of dollars in computers and even more government auditors to protect medical workers from themselves, and to "save lives'. No doubt Dell and IBM and others are already counting their money.

One concern I and others have about this issue is the lowering of standards for nursing schools. The product is just not as good as it was. And more motivated nurses are going to school to get advanced degrees so they can push paper and not take care of patients. So what is left is the less competent and less experienced.

There are times when an inexperienced doctor in training orders the wrong dose of drug; an experienced nurse will usually pick up such an error in a heartbeat. Today, we are losing these experienced nurses. Some believe automated systems will bridge this gap. I am not convinced. With medicine ever more complicated, we need both better nurses and better machines. In fact, it takes a certain amount of smarts to run the machines. The fantasy from administrators of saving money by hiring lower paid, lower skilled workers is just that - a fantasy.

We have had some new developments over the last few days regarding the online Spring Break study conducted earlier this year by the American Medical Association (AMA). The story, as long time readers will recall, involved an AMA release that initially misrepresented the study, calling it a "random sample" complete with a margin of error and implying in some instances that results from a small subgroup of women that had actually gone on Spring Break trips represented the views of all the women in the survey. While my posts on the subject received a fair amount of attention in the blogosphere, the mainstream media -- including outlets that had reported the misleading survey -- largely ignored the controversy. This week that changed.

Here are details and links:

Although I had missed it, the New York Times did make a formal correction of a Week in Review story that cited results of the poll soon after American Association for Public Opinion Research (AAPOR) President Cliff Zukin wrote the Times to complain. Their correction now appears at the end of versions of the story available on the Web or through a Nexis search:

For the Record

A chart on March 19 about the history of spring break referred incompletely to an American Medical Association survey of female college students and graduates on vacation behavior. It was conducted online and involved respondents who volunteered to participate; they were not chosen at random.

Earlier this week, the Washington Post's Howard Kurtz devoted his Media Notescolumn to the story. Kurtz reviewed some of the most colorful headlines and quotations from the initial media coverage. "At the risk of spoiling the fun," he concluded, "it must be noted that this poll had zero scientific validity."

Kurtz also quotes Richard Yoast, the director of the AMA's Department of Alcohol, Tobacco and Other Drug Abuse as saying,

[H]is organization posted a correction on its Web site to note that this was not a nationwide random sample and should not have included a margin of error, as in standard polls. "In the future, we're going to be more careful," he says.

While they are at it, the AMA might want to be a bit more careful about the way they post corrections. As noted in my original post on this subject, the AMA did correct the methodology blurb in their online release, but the corrected version includes neither a trace of the original misrepresentation nor any statement that the current version corrects the original. Also, as Kurtz points out, the corrected AMA release continues to highlight statistics based on "only the 27 percent of the 644 respondents who said they had actually been on spring break," yet still "make[s] no distinction between those who have taken such trips and those who haven't" (see this post for details).

The appearance of the Kurtz item may have been the reason that the Associated Press issued this correction just yesterday:

Correction: Spring Break Risks story

Eds: Members who used BC-Spring Break Risks, sent March 7 under a Chicago dateline, are asked to use the following story.

05-31-2006 15:23

CHICAGO (AP) _ In a March 7 story about an American Medical Association survey on spring break drinking and debauchery among college women and graduates, The Associated Press, using information provided by the AMA, erroneously reported how the results were obtained. The AMA now says participants were members of an online panel, not a random sample

Finally, today's Numbers Guy column by the Wall Street Journal's Carl Bialik takes a close look at the story and the new communications initiative that AAPOR will undertake to try to react to stories like this more quickly:

Sixty years after its founding, a key association of professional pollsters is dismayed with all the bad survey numbers in the press. In an overdue response, the group is seeking new ways to curtail coverage of faulty research...

"Our ability to conduct good public opinion and survey research is under attack from many sides," the group's long-range planning committee wrote in a May report. As part of its response, Aapor, as the group is known, plans to hire a staffer to spot and quickly respond to faulty polls.

If Aapor does come down hard, and quickly, on bad research, it could drive pollsters to do better work and disclose their methods more fully, and perhaps even introduce higher standards to what is today an unruly industry. However, a solitary staffer will be hard-pressed to improve the treatment of polls by a numbers-hungry print and electronic press. [link added]

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

Sunday, June 18, 2006

AMA: Buy insurance or face tax penalty

The Australian government already does exactly that

Hoping to prod an estimated five million uninsured Americans into buying health insurance, the American Medical Association Tuesday backed a tax penalty for individuals and families who make enough to buy medical coverage but choose not to. The AMA's policymaking House of Delegates vote in favor of what it called "individual responsibility" comes as state and federal lawmakers are weighing similar ideas in the form of legislation in Congress and statehouses across the country.

In the past, the .. AMA has shied away from government mandates as a way to provide health insurance coverage for more Americans. In this instance, the group acknowledged Tuesday at a press briefing that its support of tax penalties to encourage people to buy coverage would be a "significant shift" in the organization's thinking on matters of covering the uninsured. The vote at the group's meeting in Chicago this week means the AMA will put its lobbying clout behind state and federal initiatives that advocate a tax penalty for uninsured individuals making $49,000 or more a year and for families of four who make $100,000 or more if they do not buy medical coverage.

Under the AMA plan, individuals and families earning greater than 500 percent of the federal poverty level "would be required to obtain a minimum of catastrophic health care" coverage. The AMA would not specify the amount or specific kind of plan people should buy.

It's the latest of a growing number of legislative and political proposals that would require people to have coverage. In Massachusetts, Gov. Mitt Romney signed legislation two months ago that made his state the first to require state residents to have health insurance just as drivers must have auto insurance.

Although Romney's proposal is financed through hundreds of millions of dollars in assessments on insurers, penalties paid by employers and state Medicaid funds, the AMA's proposal is devoid of details. AMA officials did not offer a specific amount of tax penalties that would be levied against the uninsured. "This is our policy that would be used at the federal level to get uninsured people covered," said Dr. Ardis Hoven, a member of the AMA's board of trustees and an infectious disease specialist from Lexington, Ky. "I'd like to think of this as the carrot."

But the the plan's stick would most likely be wielded against those making a living wage--many of them younger individuals and families. Hoven and AMA officials said "young, relatively healthy individuals" account for most of the 11 percent, or about 5 million, of the nation's more than 45 million uninsured Americans. Passage of the measure by the AMA's House of Delegates was not without opposition among doctors and critics of such proposals in Washington. On a voice vote, AMA officials said it passed by a "large majority" of its 544-member House of Delegates. A specific vote count was not taken.

Critics of the AMA's move say the doctors are merely worried about their own bottom lines. "The AMA has a long history of sacrificing consumer freedom when physician incomes are threatened and they are doing that with this tax increase," said Michael Cannon, director of health policy studies for the libertarian Cato Institute in Washington. "They are trying to crack down on nurse practitioners because they don't like competition and I have not heard of any resolutions they have offered to make the health-care system more competitive, like opening your office longer or lowering your prices. These would be consumer friendly responses to competition."

We hear a lot from some legislators working hard to bring us peace in the world, jobs back to the U.S, higher wages for everyone, an end to terrorism and the health care we deserve. Of course, you know that health care is defined as somebody else paying for it and "free" health care is bound to cost more than anyone can afford.

When Hillary and her cronies failed to take over our health care system in 1993, they never gave up. They have been inching toward universality ever since. During that debate in 1993, we heard a lot about the Canadian Health Care system and how that should be our model. According to later articles in The New York Times and The Washington Times, the wonderful Canadian Health Care system developed serious problems.

Long waits are customary in Canada and sometimes death intervenes while awaiting the care one needs. In Toronto, overcrowding one day forced hospitals to turn away ambulances at 23 of the cities 25 hospitals. The New York Times said that a Toronto man distraught over his sick infant's condition, took a doctor hostage at gunpoint to avoid the long wait to see a physician. The police arrived and shot the man to death. No word on whether or not the infant received the care his father was seeking for him.

A 58-year-old woman who had been waiting for open-heart surgery for five years, spent the night prior to her surgery on a gurney in the hallway of the hospital. 66 other patients, spending the night in the same hallway joined her. In Vancouver, some reports are that delays are so serious that 20% of heart attack patients who need treatment in 15 minutes, are forced to wait one hour or longer. Many Canadian doctors are urging their patients to come to the United States for treatment. You don't suppose we Americans will be forced to pay for Canadians health care too, do you? Just asking.

In Canada, however, there are no problems or long waits for dental care or veterinary care. You guessed it. Both of these services have not been taken over by government and allow for private treatment. People who are required to wait for long periods of time to receive MRIs, are going to their local vet clinic in order to get them right away. In Canada, one can receive treatment for a toothache much faster than for cancer. The demand for free health care has outweighed the supply. Unable to reduce the demand, the suppliers have had to reduce the services. Results ---- long waits. It's not rocket science, folks. Lets call it The Law of Supply and Demand 101.

Remember when you hear someone say, "everyone deserves health care." Where do you draw the line? If you fall into that trap, then doesn't everyone deserve food, shelter, clothing, perhaps a new car? Our healthcare system is the best in the world. But it will eventually collapse under its own weight. It doesn't have to be this way. Most insurance covers everything from doctor visits to heart transplants and everything in between. Therein, lies the problem.

What I want is low premiums and coverage for catastrophic illness. I'll pay my own doctor visits and routine costs, thank you very much.

This started me thinking. My homeowners insurance and auto insurance is such a plan. When my plumbing goes out, I call the plumber and I pay him. I do the same with the HVAC. But if a fire or tornado comes through, I'm covered. It's the same with my car. I pay for oil changes, brakes, transmission repair, etc. I even replaced my engine a few years ago and never depended upon my insurance company. Imagine that. But, once again, if an accident happens, my insurance is there. I'm in "good hands."

Why can't health insurance be the same? Companies always pass through the cost of doing business. When you lower the cost to the consumer..voila.more is consumed. Low co pays for doctor visits equals more doctor visits and someone else paying for it (insurance companies). Then insurance companies recoup the costs in increased premiums. Around and around we go.

We haven't even mentioned the additional cost to the healthcare industry by lawsuits and skyrocketing malpractice insurance costs. Many communities across the country have no physicians because of this very real problem. We'll have to save that for another day. Just remember nothing is free. So when it's "free", we certainly can't afford it.

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

Saturday, June 17, 2006

Crisis Seen in Nation's ER Care: Capacity, Expertise Are Found Lacking

Emergency medical care in the United States is on the verge of collapse, with the nation's declining number of emergency rooms dangerously overcrowded and often unable to provide the expertise needed to treat seriously ill people in a safe and efficient manner. That's the grim conclusion of three reports released yesterday by the Institute of Medicine, the product of an extensive two-year look at emergency care. Long waits for treatment are epidemic, the reports said, with ambulances sometimes idling for hours to unload patients. Once in the ER, patients sometimes wait up to two days to be admitted to a hospital bed.

As a system, U.S. emergency care lacks stability and the capacity to respond to large disasters or epidemics, according to the 25 experts who conducted the study. It provides care of variable and often unknown quality and depends on the willingness of doctors and hospitals to lose large amounts of money. Fixing the problems is likely to cost billions of dollars and will require the leadership of a new federal agency, which Congress should create in the next two years, they wrote. "This is a crisis that could jeopardize everyone in this room, and all their loved ones," A. Brent Eastman, a surgeon and chief medical officer of the ScrippsHealth hospitals in San Diego, said at a daylong conference on the reports, which were prepared by the National Academy of Sciences' Institute of Medicine. "There is just such a gap between what the public knows, or thinks it knows, and the reality. And it is getting worse," said Robert B. Giffin, the Institute of Medicine staffer who headed the study.

The reports -- on hospital ERs, on pediatric emergency care and on pre-hospital care given by ambulance services -- were embraced by the 24,000-member American College of Emergency Physicians, and its president said that the endorsement was telling. "What other industry says, 'Hey, look at us, our whole system is broken'?" said the group's president, Frederick C. Blum, a physician in Morgantown, W.Va.

Two key steps for improving emergency care are regional planning and creating a standard way to measure outcomes, so that low-quality ERs and ambulance services can be identified and fixed, the committee wrote.

Emergency medical care is a legal right for all Americans. Under a law enacted in 1986, emergency rooms must evaluate and stabilize anyone who shows up. That requirement -- bolstered by physicians' ethical duty to treat the ill -- has made hospital emergency departments subject to unique pressures. From 1993 to 2003, the U.S. population grew by 12 percent but emergency room visits grew by 27 percent, from 90 million to 114 million. In that same period, however, 425 emergency departments closed, along with about 700 hospitals and nearly 200,000 beds.

ERs are notorious money losers. About 14 percent of ER patients are uninsured. About 16 percent are covered by Medicaid, the federal-state insurance program for the poor, and 21 percent by Medicare, the program for the elderly. More than half of hospitals report losing money on emergency care of both groups of government-insured patients. All of this has led to extreme bottlenecks in ERs, manifested by delays in every step of treatment, according to the reports.

In 2003, 501,000 ambulances were diverted from the hospital where they normally would have delivered a patient because the ER was full. In 2004, 70 percent of urban hospitals reported that their emergency departments had been "on diversion" at least once. Nationwide, about 14 percent of ER patients end up admitted to the hospital. A study by the Government Accountability Office in 2003 found that 20 percent of emergency departments had to "board" patients in hallways or other temporary space, for an average of eight hours, before a bed opened. The American College of Emergency Physicians several years ago surveyed 90 emergency departments on a single Monday evening. Seventy-three percent reported that they had two or more patients boarding.

A 2004 study found that ERs at university-based hospitals were classified as crowded 35 percent of the time, meaning all emergency beds were occupied, patients were in the hallways, the waiting room was full, and the waiting time for treatment was more than one hour. Another hazard largely unrecognized by Americans is that hospitals, especially in rural areas, often cannot find specialists such as orthopedic surgeons and neurosurgeons willing to cover the ER. In some cases, this is because doctors are unwilling to treat high-risk patients with complicated ailments, many of them uninsured, at inconvenient times. Sometimes it is simply a function of shortages. In 2002, there were fewer practicing neurosurgeons in the United States (about 3,000) than a decade earlier.

Largely unknown is the human cost of these problems. Many studies have shown that high-stress, chaotic environments contribute to errors. One from 1991 showed that though relatively few "adverse outcomes" occur in the ER, it was the site of 70 percent of those attributable to negligence. The number of deaths caused by a delay in treatment or lack of expertise is especially uncertain, though it may not be small. San Diego established a trauma system in 1984 after autopsies of accident victims who died after reaching the ER suggested that 22 percent of the deaths were preventable, said Eastman, one of the Institute of Medicine committee members.

Trauma care in many ways is the model on which the committee hopes the emergency care system will be rebuilt. Some states and urban areas have systems in which the level of trauma care every hospital is capable of providing is known and a centralized dispatching agency directs patients based on real-time information about each hospital's capacity and staffing. Although the vast majority of ER patients have not suffered trauma, about half need attention within an hour of arrival at the hospital, according to a study in 2003. Because not every hospital or even every city can provide all services, "the committee supports further regionalization of emergency care services," the authors wrote.

Even without systemwide reform, hospitals can do many things to make the flow of patients more efficient and to be ready for predictable spikes in demand, said Benjamin K. Chu, an ER physician and regional president of a Kaiser Health Plan in California who was also on the expert panel.

The report on ambulance service called for standardizing the training of paramedics and creating guidelines for pre-hospital care based on research. The report on pediatric care emphasized that 27 percent of ER patients are children and that many hospitals lack the expertise or the equipment to meet the needs of those who are critically ill.

The District's emergency and trauma services measure up well. A report this year gave the city an A-plus in "its support of an emergency care system." Though the assessment was somewhat skewed by the District's compact geography and urban makeup, population-adjusted numbers showed more emergency departments, board-certified emergency doctors, hospital-staffed beds and trauma centers than in any state, and probably more than in many local jurisdictions, although the report did not look so narrowly.

Still, the American College of Emergency Physicians noted, emergency services in the city "are regularly reaching their capacity, and patients are frequently and increasingly diverted to other facilities." In 2004, for example, Washington Hospital Center's ER was "on diversion" for nearly 2,100 hours. Howard University Hospital's ER turned away patients for the same reasons for almost 1,200 hours.

To help cut its health care costs, Blue Ridge Paper Products is considering a program that gives employees the option of traveling to India to receive medical care. “If the due diligence and feasibility checks out positively, then we plan to offer this as an option,” said Darrell Douglas, the company’s vice president of human resources. The possibility of significant savings has led Blue Ridge Paper to consider the plan, which includes company-paid travel and lodging for a family member and the patient to undergo approved procedures at an internationally accredited hospital in New Delhi or elsewhere in India.

The kicker for the patient is the opportunity to share in up to 25 percent of those savings, which could amount to thousands of dollars for a hip procedure that costs $50,000 in North Carolina, but only about $18,000 in India, including the related travel expenses for two people.

To look into the program, Blue Ridge Paper is working with IndUShealth, a Raleigh company that coordinates overseas health care in Indian hospitals for American patients. “We’re not exporting health care to India as much as importing competition in the United States,” said company President Tom Keesling, a former hospital CEO who helped launch IndUShealth last year.

The number of Americans traveling to countries such as India and Thailand for health care is rising, drawing increasing interest in what has been dubbed “medical tourism.” “It is a leading-edge type of service that’s just beginning to get some attention,” said senior health care consultant Steve Graybill of the Charlotte office of Mercer Health & Benefits, a New York-based consulting firm.

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

Friday, June 16, 2006

Left-leaning doctors promote sweeping social meddling

The American Medical Association, meeting in Chicago this week, will consider a controversial proposal to fight obesity by taxing soda pop. A committee of the influential doctors' group is recommending the AMA lobby for a "small" federal tax on sugar-sweetened soft drinks, with proceeds going to anti-obesity efforts such as physical activity programs and healthier school meals. The committee did not specify how high the tax should be. But a consumer group, Center for Science in the Public Interest, estimates that a 1 cent a can tax would raise $1.5 billion a year. That's more than the advertising budget of McDonald's.

These are among the proposals the American Medical Association will consider this week during its annual meeting at the Hilton Chicago: Support a 50 percent reduction in salt in processed foods, fast foods and restaurant meals over the next decade. Urge health insurance plans to cover stomach-stapling surgery for weight loss. Oppose beer ads on college sports broadcasts. Prepare a report summarizing video game research, including emotional and behavioral effects and addictive potential. Push to ban smoking in all public places and workplaces. Urge school health classes to "discuss the importance of routine pap smears in the prevention of cervical cancer." Support mandatory school instruction on the dangers of Internet pornography.

During its five-day meeting, the AMA's governing House of Delegates can accept, reject, amend or table these and dozens of other proposals. A 12-ounce can of Pepsi contains 150 calories of sugar or high fructose corn syrup -- the equivalent of 10 teaspoons of sugar or a 3.2-ounce reduced-fat ice cream cone at McDonald's.

In the late 1970s, teens drank nearly twice as much milk as soft drinks; now they drink twice as much soft drinks as milk. Pop is "devoid of nutritional value" and contributes to increasing obesity rates, the AMA committee said. The committee cited one study that found the odds of a child becoming obese increases 60 percent for each additional can of pop consumed each day. However, the committee report noted that other studies have found no link between soft drinks and obesity. The AMA committee also endorsed soda pop taxes imposed by state and local governments. Diet pop, flavored milk and sugary fruit drinks should be exempt, the committee said.

More than a dozen states have passed soft-drink taxes, but in recent years several states have repealed such taxes. States typically use soft-drink taxes for general purposes, rather than for obesity programs. Taxing soft drinks is "misguided," said Kevin Keane of the American Beverage Association. "It will not move the needle one ounce in addressing health and wellness issues." Doctors should know better than to target a single food, Keane said. "People consume a lot of calories every day. Why pick on one particular product?"

Of course, soda pop is not the only cause of the obesity epidemic. But pop makes an easy target because it has no redeeming nutritional value, said Michael Jacobson of the Center for Science in the Public Interest. "It's a simply defined category of food that's pure junk." The AMA's House of Delegates can accept, reject, amend or table the committee's recommendation. An AMA endorsement of a soft drink tax could be "extremely useful" to legislators who push such measures, Jacobson said. However, he added that a federal soda pop tax is unlikely. "Tax increases are not popular with this administration or Congress," Jacobson said. "It would be dead on arrival."

Health chiefs want to use 'lean thinking' management techniques to remedy an inefficient service

Hospitals and surgeries need to adopt the "lean" management techniques used by companies such as Tesco and Toyota to reduce the inefficiency and hold-ups experienced by patients in the NHS. Health service leaders want hospitals to improve their service by better understanding how patient demand varies and identifying and removing the valueless activities that create bottlenecks in the system.

These include getting patients from accident and emergency to the operating theatre more quickly by removing unnecessary paperwork and reducing the number of different staff involved. It also involves improving the layout of hospitals, so that waiting rooms and items such as diagnostic machines are where they are needed most, to save time and money and reduce patient and staff stress.

One hospital trying the "lean" approach, a production methodology first developed about 60 years ago by Toyota, found that processing a routine blood sample involved 309 separate steps, which it reduced to 57 with simple changes. They also found that under the current system more than 250 different interactions took place to discharge a patient with complex health problems. A report commissioned by the NHS Confederation, Lean Thinking for the NHS, concludes that the lean system, which is also used by the Royal Navy and Royal Air Force, could revolutionise health care and dramatically improve quality and efficiency.

The key is to remove activities that do not add value to the customer, or patient, by redesigning how services work. Early results of a study by Bolton Hospitals NHS Trust, with the assistance of the RAF, showed that the lean method helped to cut by a third death rates for patients having hip operations; reduced paperwork in the trauma unit by 42 per cent; and halved the amount of space needed by the pathology department.

Nigel Edwards, policy director of the NHS Confederation, which represents health service managers, said: "Many ideas about the organisation of work are deeply held and often wrong." Australian health chiefs at Flinders Medical Centre in Adelaide, who redesigned their care based on the lean model, found that it allowed them to do about 20 per cent more work and offer a safer service on the same budget and using the same infrastructure, staff and technology. Gill Morgan, the NHS Confederation's chief executive, said that more was needed to improve frontline services. "The NHS can learn from the latest thinking as adopted by the Royal Navy, RAF, Tesco and Toyota. NHS managers want to be at the vanguard of modern techniques to improve patient care." She said that the pioneering work done at Bolton and Wirral, which had also adopted the method, showed what could be done. David Fillingham, chief executive of Bolton Hospitals NHS Trust, added: "When we started out, some people were very sceptical. But I've never seen anything that energises staff in this way."

Results of a survey of 203 NHS chief executives, released by the confederation at its annual conference yesterday, showed that 95 per cent accepted that the NHS must increase productivity and cut waste before they could justify more government funding. Tony Blair has also called for trusts to improve efficiency. In an interview with Health Service Journal, published today, he says that the principles of quality healthcare provided equitably and free would remain abstract concepts without good NHS management. The Royal Navy adopted the lean method after it felt pressure to reduce its aircraft support costs by 20 per cent. It managed to reduce the number of aircraft repair bases and saved millions of pounds on its Sea King and Lynx helicopter operations.

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

Background

Postings from Brisbane, Australia by John Ray (M.A.; Ph.D.) -- former member of the Australia-Soviet Friendship Society, former anarcho-capitalist and former member of the British Conservative party.

This blog gives a lot of attention to events in Australia and Britain -- places where there already exist systems similar to the one most likely to befall the USA if the Democrats get their way -- "Free" medical care supposedly available to all through government hospitals but with a competing private sector as well. The Canadian system is considered too Soviet to provide a likely model for the USA

TERMINOLOGY: Many of my posts concern the very instructive state of socialized medicine in Australia. Like the USA, Germany and India, Australia has a system of State governments which have substantial independence from the central (Federal) government and it is they who are mainly responsible for "free" health services. It may therefore be useful to some for me to note the standard abbreviations for the States concerned: QLD (Queensland), NSW (New South Wales), WA (Western Australia), VIC (Victoria), TAS (Tasmania), SA (South Australia).

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Conservatives do NOT object to helping the poor. Government welfare legislation in aid of the poor was in fact first introduced by conservatives -- Bismarck and Disraeli in the 19th century. What conservatives want is for the help to be delivered in a sane manner. And anyone who thinks that government bureaucracies can run hospitals well is completely out of touch with reality.

One of the oldest "free" public hospital systems in the world is that in the Australian State where I live: Queensland. It dates from 1944 (Britain's NHS began in 1948). So its advanced state of decay reveals well where the slow cancer of bureaucracy ends up. It now has three "administrative" employees for every medical employee. All those clerks are really good at curing people, I guess! Frequent bulletins on the flailing but ineffectual attempts to "fix" the system will appear here -- as well as bulletins on the dreadful things it does to patients and the long waits they endure.

On all my blogs, I express my view of what is important primarily by the readings that I select for posting. I do however on occasions add personal comments in italicized form at the beginning of an article.

I am rather pleased to report that I am a lifelong conservative. Out of intellectual curiosity, I did in my youth join organizations from right across the political spectrum so I am certainly not closed-minded and am very familiar with the full spectrum of political thinking. Nonetheless, I did not have to undergo the lurch from Left to Right that so many people undergo. At age 13 I used my pocket-money to subscribe to the "Reader's Digest" -- the main conservative organ available in small town Australia of the 1950s. I have learnt much since but am pleased and amused to note that history has since confirmed most of what I thought at that early age.

I imagine that the the RD is still sending mailouts to my 1950s address!

NOTE: The archives provided by blogspot below are rather inconvenient. They break each month up into small bits. If you want to scan whole months at a time, the backup archives will suit better. See here or here